5 Reasons Why I’m Switching Back to Tricare Standard

When we got orders to PCS overseas, one of the things I was dreading was using Tricare Prime for our health care. I was a staunch Tricare Standard user for more than 11 years.

While Prime hasn’t been quite as horrible as I imagined (mainly because we are stationed right next to Europe’s ONLY military hospital), we have still had some major frustrations.

When I recently received a notification from Relay Health, Army Medicine’s messaging system, letting me know that there had been a sudden departure of virtually every pediatrician and family practice practitioner at the hospital, so we could expect very long delays in getting appointments until at least September, I renewed my vow to immediately sign up for Tricare Standard when we get back to the States next year.

Here are the 5 reasons why I’m switching back to Tricare Standard.

Timely Access to Medical Care

This is my biggest peeve with Tricare Prime Overseas: it is virtually impossible to get in to see the doctor.

Theoretically, the phone lines open at 6:30 a.m. to allow us to get same-day appointments. But there have been many days in recent months when due to a shortage of providers there are no appointments available at all or when the next possible appointment of any kind is more than 30 days out. So something completely non-urgent, like conjunctivitis, becomes an emergency room affair lasting 4 or 5 hours. For minor irritations, like a persistent cough, seasonal allergies or a shoulder that hurts, I don’t even bother with trying to go to the doctor.

In the States when I was on Standard I was always fortunate enough to find a pediatrician who had same day appointments for sick patients. For more immediate needs, Tricare Standard has many authorized urgent care centers. Over here, for now, it’s the ER or nothing at all.

You Choose Your Doctors

That pediatrician who has a cold bedside manner? That family practice doctor who keeps giving you Motrin instead of ordering an MRI? Guess what? If you’re on Tricare Standard, you don’t have to see them again. You can switch doctors whenever you want. You don’t need anyone’s permission. As long as they will see Standard patients (and trust me, many if not most doctors do), they will see you.

Yes, Tricare Prime patients can get their Primary Care Manager (PCM) changed–and we’ve done it–but you are limited to an extremely small pool to choose from. You can also get referrals to outside specialists, but it can take a very long time. Especially over here where referrals must come from a PCM and it can take months to get in to see them.

You Don’t Need Referrals for Most Care

Think your kid broke her foot at soccer practice? Want to have that mole checked out by the dermatologist? Well, get this, you don’t need to go see your primary care doctor and wait and wait to be referred to a specialist. Yes, you can phone and make appointments with the dermatologist, the cardiologist or any other “ist” you can think of.

In fact, only a handful of services need any kind of authorization (always contact your region’s administrator for specific questions).

You Can Easily Fill Prescriptions– Even at Drive-Thrus!!!

My kids dread getting a prescription by the doctor. That’s because the pharmacy is typically packed and it can take an hour or more to get any prescription filled. Even when you drop off a prescription at the MTF pharmacy, you will wait in line to drop it off and then pull a number and then wait again to pick it up.

While Tricare Standard does encourage you to get maintenance prescriptions through the mail order pharmacy, you can actually get your prescriptions filled almost anywhere. Yes, there’s a co-pay and the amount depends on where you get your prescription filled. If you don’t want to pay anything, go ahead and take a number at the MTF, because prescriptions there are still free.

But if you’re willing to follow my tip below for keeping costs down, then you have a lot of freedom to get prescriptions filled wherever you want.

It’s Affordable

High out-of-pocket costs. This is usually the top reason why people are afraid of Tricare Standard. While there is definitely some cost involved, it is actually ridiculously low when you compare it to similar health care in the civilian sector.

The deductible is only $300 per year per family and if you are below E-5 in rank, the deductible drops to just $100 per family. Once you have satisfied the deductible, then depending on whether the doctor is in or out of network, Tricare pays 80 to 85% of the cost of a visit.

This might make you uneasy, but there’s a way to keep these costs down–by getting a Tricare Standard Supplement offered by many military associations and insurance companies. We had ours through MOAA for many years.

Here’s how it works: pay the relatively low quarterly cost for the supplemental insurance policy (I paid about $100 per quarter for our entire family), satisfy your family’s deductible and then the supplement will take care of what Tricare doesn’t cover–the 15 to 20% copay and ALL the prescription copays. Even if you decided not to get a supplement, Tricare has something called a catastrophic cap which limits your out-of-pocket costs for your entire family to $1,000 per year.

Some people have asked why we haven’t switched to Tricare Standard here in Germany, but we were a bit hesitant about the language and culture barrier. Plus, most German doctors require full payment up-front (and you file the claim yourself) rather than accepting the copay.

Tricare Standard is fabulous health care. For under $1,000 per year we were able to see top local doctors and have all our prescription needs filled. Most of all, for our family, Tricare Standard provided peace of mind– knowing that we had the level of health care we had chosen, on our own terms. That’s something Tricare Prime can’t give me. While I am certainly enjoying being stationed abroad, the second we get to the States, I’m switching back to Standard!

How do you feel about Tricare Standard? Do you prefer Tricare Standard instead of Tricare Prime? Why?

About Lila Quintiliani

Lila is a veteran, a mom and a military spouse. She has degrees in East Asian Studies, History and Computer Programming (really!) and is an Accredited Financial Counselor. Currently stationed overseas, she has visited over 20 countries but still finds herself occasionally missing the end caps at Target.

Comments

My husband and I just got married and I will be switing to TRICARE. I do not want prime honestly BC I want to pick who is my Dr. This article along with some others make it clear that for me at least Standard is the way to go.

I do have one question I can’t find the answer to… In the health insurance from my job things like physicals and well child visits are covered 100% along with 1x a year vision. On standard.. Are things like that covered or is there still an out of pocket expense?